Provider Demographics
NPI:1114088192
Name:DELMARVA COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:DELMARVA COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-221-1900
Mailing Address - Street 1:2450 CAMBRIDGE BELTWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3679
Mailing Address - Country:US
Mailing Address - Phone:410-221-1900
Mailing Address - Fax:410-221-1952
Practice Address - Street 1:6210 SHILOH CHURCH HURLOCK RD
Practice Address - Street 2:
Practice Address - City:HURLOCK
Practice Address - State:MD
Practice Address - Zip Code:21613
Practice Address - Country:US
Practice Address - Phone:410-943-1106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TM1800X, 103TR0400X
MD10446251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD334333200Medicaid
DE0000722856Medicaid
MD024613100Medicaid